MEDICARE: CEO CENTER FOR EXECUTIVE OPHTHALMOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME044196	FL

General Provider Information

NPI Number	:	1770751737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEO CENTER FOR EXECUTIVE OPHTHALMOLOGY

Provider Business Mailing Address
First Line	:	10260 SW 56TH ST
Second Line	:	SUITE 104
City	:	MIAMI
State	:	FL
Zip	:	33165-7001
Country	:	US
Telephone Number	:	305-666-2365
Fax Number	:

Provider Business Practice Location Address
First Line	:	10260 SW 56TH ST
Second Line	:	SUITE 104
City	:	MIAMI
State	:	FL
Zip	:	33165-7001
Country	:	US
Telephone Number	:	305-666-2365
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALFRED H RIVERA
Credential	:	MD
Telephone Number	:	305-666-2365

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	03/21/2008

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